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This study aims to explore the empirical correlation between patient flow issues, quality of green health services and patient satisfaction in specialist medical department factors from patients’ perspectives as service consumers.

This research is a type of nonintervention empirical research that uses an open survey to explore the views and experiences of users of specialist medical department services. The targeted population is hospital patients included in the top five national PERSI (Indonesian Hospital Association) Award 2022 Green Hospital Category, with a total number of respondents of 572 people. This study uses the partial least square-structural equation modeling analysis method with the SmartPLS application.

Patient flow problems generally affect the quality of eco-friendly health services, except for the waiting time problem, which affects service quality. It should be understood as a top priority for patients to receive services from medical specialists without risking time as a core service aspect from the patient’s perspective. In addition, all variables in eco-friendly hospital services affect patient satisfaction, except in the case of visits to specialist medical departments, which do not affect medical support services and hospital practices that are responsive to the delivery of care services resulting from medical support services that are inseparable in integrated services as well as health care following medical ethics.

This study has a novelty in understanding the implications of green practice in determining patient satisfaction in medical specialist department as the epicenter of hospital services and the main object of assessment for the quality of hospital services.

A region’s transforming care partnership identified that autistic adults without an intellectual disability (ID) may be falling through gaps in services when presenting with a significant emotional and/or behavioural need in the absence of a mental health diagnosis. The region’s intensive support teams (ISTs) for adults with ID therefore piloted a short-term “behavioural support service” for this population. The purpose of this paper is to evaluate this pilot.

This study represents a mixed-methods service evaluation over a four year pilot period. The quantitative component examined referral rates and demographic data of accepted and declined referrals; and length of referral episodes and Health of The Nation Outcomes Scores (HoNOS) for accepted referrals. The qualitative component used thematic analysis to identify key themes relating to reasons for referral, clinical/therapeutic needs, and the models of support that most informed assessments and interventions at individual and systems levels.

The ISTs accepted 30 referrals and declined 53. Most accepted referrals were male (83%), and under 24 years old (57%). Average HoNOS scores were above the thresholds generally associated with hospital admission. Key qualitative themes were: transitional support; sexual risks/vulnerabilities; physical aggression; domestic violence; and attachment, trauma and personality difficulties. Support mostly followed psychotherapeutic modalities couched in trauma, attachment and second- and third-wave cognitive behavioural therapies. Positive Behaviour Support (PBS) did not emerge as a model of preference for service users or professionals.

This project represents one of the first of this type for autistic adults without an ID in the UK. It provides recommendations for future service development and research, with implications for Transforming Care policy and guidance.

This paper aims to introduce the concept of using the well-established Shared Lives approach to support survivors of domestic abuse with complex needs including those with learning and physical disabilities, older people and carers.

Survivors with complex needs are often excluded from traditional domestic abuse support services thus increasing their risk and making recovery impossible. Using the Shared Lives approach in suitable cases could address gaps in provision and improve the outcomes for survivors with disabilities, older survivors and carers.

The paper draws on evidence from reports and research about the experiences of these cohorts of survivors to explain how the Shared Lives approach could increase support options for specific categories of survivors.

Using the Shared Lives approach to support cohorts of victims/survivors who experience barriers to accessing support could improve outcomes for these people, reduce risk of serious harm and improve quality of life.

With the recent recommendation from Association of Directors of Adult Social Services around increasing use of Shared Lives, this paper provides one potential way to meet this recommendation.

How can large international financial firms go green in authentic ways? What enhances ‘Net Zero action’? Changes in global banks, fund managers, and insurance firms are at the heart of green finance. External change pressures – combined with problematic firm predispositions – exacerbate barriers to change and promote scepticism about authentic Net Zero change. Field research reveals main elements, connections, and interactions of this question by considering financial firms as complex socio-technical systems (Mitleton-Kelly, 2003). An interdisciplinary/holistic narrative approach (De Bakker et al., 2019) is adopted to design a conceptual framework that can support a green ‘behavioural theory of the financial firm’ (green BTFF). The BTFF presents an international version (Peng, 2001) of the resource-based view (RBV) of the firm (Barney, 1991; Hart, 1995; Teece et al., 1997).

The approach of this chapter is aimed at closing knowledge gaps and realign values in financial markets and society. By raising awareness about organised hypocrisy and facades (Brunsson, 1993; Cho et al., 2015; Schoeneborn et al., 2020) in financial firms the chapter aims at overcoming the gap between ‘talking’ and ‘walking’ in the financial sector. The chapter defines testable firm-level hypotheses for ‘Green Finance’ (Poterba, 2021) as well as – by implication – tests for ‘greenwashing’.

This article examines challenges and strategies related to police relationships and engagement with rural communities in England and Wales, Australia and France. It aims to bridge a gap in knowledge around how police balance public demands with organisational and contextual constraints, exploring the role of communication technology in overcoming geographical and cultural barriers in rural policing.

The research draws upon 121 semi-structured interviews conducted across three distinct jurisdictions. In the United Kingdom and Australia, interviews were conducted via Microsoft Teams, while face-to-face interviews were conducted in France. Participants were recruited through the purposive sampling of police working in rural areas. The data were thematically analysed using NVivo Software.

Rural communities have low expectations of policing services, a consequence of geography, organisational structures and limited resource allocation. Building relationships can be challenging owing to isolation and terrain, the need for officers to have local and cultural knowledge, and difficulties in recruiting officers in rural posts. Technology-mediated communication has played a part in the solutions (e.g. social media). However, this may not always be suitable owing to limited connectivity, citizen and police preferences for communication and engagement, and the institutional and cultural nuances surrounding the application of technology.

This article provides empirical insights into the attitudes and experiences of rural police officers, highlighting the distinctive policing context and engagement needs of rural communities. The research underscores the necessity for contextually aware engagement. It suggests that while technology-mediated communication offers some solutions to spatial challenges, its effectiveness may be limited by access, generational preferences and the adaptability of police institutions and cultures.

A quantitative observational study was conducted. The purpose of this study is to examine the continuing adherence to the stopping over-medication of people with intellectual disability and/or autism guidelines for a cohort of outpatients seen in the outpatients’ clinics in the two teams who participated in this study to review the trend of psychotropic prescribing with a prescription indication along with the utilisation of non-pharmacological interventions.

Data was retrospectively collected over a period of one year for patients sampled conveniently in the outpatient’s clinic. The data was collected from two sites from psychiatric letters to the general practitioners (GPs), with the focus being psychotropic prescription indication and their adherence to British National Formulary limits, inclusion of a wider multi-disciplinary team or MDT (including nurses, psychologists and health support workers), use of Clinical Global Impression (CGI) scale for assessing medication side effects and response to treatment.

Most of the patients had at least one review in the previous six months. Antipsychotics were the highest prescribed medications without an indication for their use (13.3%) followed by anxiolytics and other medications. CGI recording was suboptimal, with 26% of the patient population did not have medication side effects and effectiveness monitored through this method. In total, 41% of patients were open to community nurses followed by other disciplines.

To the best of the authors’ knowledge, this is an original article following the pilot study completed by the authors.

Despite a significant evidence base illustrating the issue of housing insecurity and homelessness experienced by women over the age of 55 in Australia [Pawson et al., 2018; Australian Institute of Health and Welfare (AIHW), 2021b; Mission Australia 2022; Per Capita 2022], there continues to be a knowledge gap in the representation of older women in current Federal and New South Wales (NSW) State Government housing and homelessness policies and initiatives. This paper aims to identify the extent and ways in which older women were represented (or not represented) in the Federal and NSW State housing and homelessness policies in 2022.

Of the total primary and supplementary Federal and NSW State policy and strategy documents, 16 were collected through a systematic review and then analysed using a Critical Discourse Analysis (CDA) framework and feminist lens to explore quotes, phrases, keywords and language choices which suggested prevalent themes, rhetorical devices and dominant discourses.

Three significant themes were identified by the analysis (1) “relinquished responsibility”, (2) “inconsistent rhetoric” and (3) “homogenising and ideological cherry picking”. These themes presented the authors with three main discussion points to inform policy reform which we have addressed in relation to policy implications, evidence-based policy decision-making and impacts on older women.

The combination of a systematic review with CDA provides a unique approach to exploring homelessness policy for older women.

The new Italian National Recovery and Resilience Plan (NRRP) has prioritised a new healthcare model that will establish the additional community healthcare facilities (CHFs). The paper proposes a methodology for supporting decision-making on location of the future facilities according to new parameters that consider how proximity to healthcare benefits communities. Rethinking the spatial parameters for locating future CHFs, focusing on fragile areas, creates a novel decision support system.

The methodology is based on multifactor analysis and on geographic information system (GIS) mapping to simulate the potential and risks associated with the proposed location of CHFs, focusing on territorial contexts of metropolitan cities, medium-sized cities, and Inner Areas, characterized by different fragilities. This method aims to innovate urban planning practices by updating the practice of per-capita urban planning standards and promoting implementation of the 15-minute city model.

The method defines new spatial parameters useful to inform the appropriate location of CHFs in Italy's Inner Areas. This offers a new integrated approach to spatial design mixing urban planning and healthcare dimensions.

The methodology will bring about an integrated urban planning approach, which guides both transformative urban choices and health services' implementation according to the needs of communities.

The dermatology service on the islands of Orkney, with a population of approximately 22,500, was taken over by National Health Service (NHS) Tayside in August 2018. This paper aims to provide an overview of the planning and review of a highly efficient and effective dermatology service for a rural island population.

The service includes visiting dermatology consultants, enhanced electronic referral vetting, skin surgery services, a General Practice (GP) with extended role (GPwER) in dermatology, specialist virtual clinics, urgent advice for inpatients at the local district general hospital and remote systemic therapy monitoring. A new phototherapy service has been set up in an island GP practice.

Local GPs and consultant dermatologists find the enhanced vetting service useable, efficient and educational. Between August 2018 and November 2022, there have been 1,749 referrals. Of these referrals, 60% were seen in clinic or a GPwER surgery, with 40% managed remotely by providing advice back to the referring GP. The number of consultations performed by the GPwER has grown over the past 3 years, and in the last year, it accounted for more than 50% of patient appointments. The waiting time has been significantly reduced using this model.

This remote service uses an integrated approach of teledermatology (TD) whilst offering continual in-person services using local capabilities including a GPwER and island general surgeons. New treatment facilities are provided to the island population. Continual educational feedback to the primary care referrer is provided, and it enhances relationships that greatly aid the high-quality dermatology service provided.

This paper aims to understand the clinical practice of physiotherapists and occupational therapists in the Republic of Ireland in the assessment and treatment of spasticity in adults, to inform and improve spasticity management practice. This study also aims to describe therapists’ knowledge, confidence and perceived barriers in the management of spasticity.

A cross sectional survey design study was completed, and respondents were recruited through an online survey.

In total, 92 respondents from a wide range of clinical settings revealed there is considerable variation in services available nationally for adults presenting with spasticity. There were significant inconsistencies across all areas of practice. The majority of respondents (94%) did provide intervention to patients with spasticity, yet three quarters did not have access to a specialist spasticity clinic, and the majority (82%) did not feel they were providing sufficient treatment intensity for spasticity.

These findings provide a unique insight into the assessment and treatment practices of Irish physiotherapists and occupational therapists. These results demonstrate the need for further upskilling and specialist high-quality spasticity services nationally.